Nursing practice and effect evaluation of cupping therapy in the rehabilitation of sports-induced cervical spine injuries

Cupping has been extensively used in the treatment of various medical conditions since antiquity. In this randomized controlled trial, we investigated the effects of wet cupping therapy on the outcomes of football athletes with cervical spine injuries and low back pain. Our study was conducted at the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine involving 40 athletes consisting of 28 males and 12 females. Single blinding was used and participants were divided into an intervention (wet cupping) and a sham group. Our findings showed significant reduction in pain intensity scores from the pre-intervention (7.2 ± 1.5) to post-intervention (4.5 ± 1.2), suggesting a positive effect of wet cupping therapy on cervical spine injuries (Mean Difference [MD] = -2.7 ± 1.3, p = 0.001). Statistically significant increase in functional improvements in the intervention group from pre-intervention (28.3 ± 4.0) to post-intervention (18.9 ± 3.5) due to the wet cupping therapy (MD = -9.4 ± 2.1, p = 0.021). Significant improvements in the range of motion assessed from cervical flexion, cervical extension, cervical lateral flexion, and cervical rotation. Sleep quality based on Pittsburgh Sleep Quality Index (PSQI) scores exhibited a mean difference of -1.4 ± 1.2 which was statistically significant (p = 0.001). Muscle strength of Neck Flexors, Neck Extensors, Upper Trapezius, Rhomboids, Cervical Rotators, Deltoids and Biceps were significantly while minimal adverse outcomes were observed in the intervention group. In conclusion, the application of wet cupping therapy could be an effective treatment for alleviating pain, improving muscle strength, quality of life, range of motion, functional improvements and reducing adverse outcomes in athletes with cervical spine injuries (AU)

Spinal Accessory and Suprascapular Nerve Injury After Human Bite.

ABSTRACT: This is a unique clinical case of spinal accessory and suprascapular nerve injury related to a human bite not yet described elsewhere. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular nerve injury.

Efectividad de la técnica de liberación de la fascia toracolumbar sobre la resistencia muscular del esternocleidomastoideo bilateral y el ángulo de anteposición de cabeza y cuello / Effectiveness of thoracolumbar myofascial release on increasing sternocleidomastoid resistance and reducing forward head posture angle

Objetivo: el propósito del estudio fue evaluar la efectividad inmediata de la técnica de liberación de la fascia toracolumbar para aumentar la resistencia muscular del esternocleidomastoideo bilateral, y disminuir el ángulo de anteposición de cabeza y cuello en mujeres jóvenes de la Universidad Autónoma de Chile. Material y métodos: este estudio longitudinal, está basado en la medición inmediata (5minutos) de la resistencia muscular (segundos) a través de la prueba de fatiga mediante electromiografía de superficie en el esternocleidomastoideo bilateral, y análisis del ángulo de anteposición de cabeza y cuello posterior a la aplicación de la técnica de liberación de la fascia toracolumbar (TLFT). Las 35 mujeres evaluadas reunieron los criterios de inclusión de: sexo femenino, edad entre 22 y 27 años, sedentarias, estudiantes de nivel superior de la Universidad Autónoma de Chile, anteposición de cabeza y cuello entre 43,8 y 51 grados, índice de masa corporal normal y sobrepeso, sin enfermedades de columna y firmar consentimiento informado. Resultados: hubo cambios estadísticamente significativos de manera inmediata en la resistencia muscular del esternocleidomastoideo, con un aumento de 27,4segundos promedio (p<0,05) y la disminución del ángulo de anteposición de cabeza y cuello de 2,8 grados promedio (p<0,05), posterior a la aplicación de la TLFT. Conclusión: la TLFT produce un efecto inmediato en el aumento de la resistencia muscular del esternocleidomastoideo bilateral y una disminución del ángulo de anteposición de cabeza y cuello en mujeres jóvenes que presenten anteposición de cabeza y cuello

Objective: the aim of this study was to evaluate the effectiveness of thoracolumbar myofascial release to increase the resistance of the sternocleidomastoid (SCM) muscle bilaterally and to decrease the angle of forward head posture in young women enrolled at the Autónoma University of Chile. Material and methods: this longitudinal study was based on the immediate measurement (5minutes) of muscular resistance (seconds) through the fatigue test by means of surface electromyography in the bilateral sternocleidomastoid and analysis of the angle of forward head posture after the application of thoracolumbar myofascial release (TMFR). The 35 women evaluated met the inclusion criteria of female sex, age between 22 and 27 years, sedentary lifestyle, senior students of the Autónoma University of Chile, forward angle head posture between 43.8 and 51 degrees, body mass index indicating normal weight or overweight, and without spinal abnormalities. All participants provided written informed consent. Results: after the application of TMFR, there were statistically significant and immediate changes in the muscular resistance of the sternocleidomastoid with an average increase of 27.4seconds (P<.05) and an average decrease in the forward head posture angle of 2.8 degrees (P<.05). Conclusion: TMFR produces an immediate effect in increasing the muscular resistance of the bilateral sternocleidomastoid and reducing the forward head posture angle in young women with forward head posture

Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study.

INTRODUCTION: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas. METHODS: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics. RESULTS: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS. CONCLUSIONS: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns.

Fiabilidad interexaminador de la exploración de puntos gatillo miofasciales en la musculatura de las regiones cervical y lumbar / Inter-examiner reliability of the examination of trigger points in the cervical and lumbar spine regions

Objetivo: Conocer el grado de concordancia y la correlación interexaminadores al realizar la exploración manual de las características de banda tensa, banda sensible, dolor referido, dolor familiar, la respuesta de espasmo local y la algometría en los puntos gatillo explorados. Material y método: Estudio observacional prospectivo con 30 sujetos, 8 hombres (media: 36,55 años; desviación estándar:7,21) y 22 mujeres (44,53 años; desviación estándar: 0,81). Los examinadores fueron 2 fisioterapeutas noveles (N1 y N2) y un examinador experto (E1). Los músculos explorados: esternocleidomastoideo, trapecio superior, elevador de escápula, infraespinoso, cuadrado lumbar, glúteo medio y piramidal. Resultados: Kappa sustancial o casi perfecto entre examinadores para el lado dominante, excepto el dolor referido en el músculo piramidal con 0,35 (intervalo confianza -IC-95 por mil : 0 a 0,92) entre N1 frente a N2, 0,20(0 a 0,66) entre E1 frente a N2 y 0,27(0 a 0,77) entre E1 frente a N1 y la respuesta de espasmo local con 0,34(0 a 0,70) entre N1 frente a N2 para el músculo infraespinoso y 0(0,13 a 0,80) para el músculo trapecio superior. La correlación intraclase ha sido buena o muy buena para todos los músculos explorados, exceptuando el músculo elevador de escápula entre E1 frente a N1 con 0,68(0,44 a 0,83) y entre E1 frente a N2 con 0,69(0,45 a 0,84). Conclusiones: Obtenemos valor Kappa sustancial y/o casi perfecto entre examinadores, exceptuando en el dolor referido y la respuesta de espasmo local en algún músculo. Por otro lado, en el CCI para los valores de algometría, muestran una correlación buena o muy buena para todos los músculos a excepción del elevador de escápula

Objective: To determine the level of agreement and inter-rater reliability when performing the manual examination of the characteristics of taut band, sensitive edge, referred pain, familiar pain, local twitch response, and the algometry explored. Methods: A prospective observational study was conducted on 30 subjects including 8 men (mean: 36.55 years, standard deviation: 7.21) and 22 women (44.53 years old, standard deviation: 0.81). The examiners were 2 non-expert physiotherapists (N1 and N2) and an expert examiner (E1). Muscles explored: sternocleidomastoid, upper trapezius, levator scapula, infraspinatus, lumbar square, gluteus medius, and piriform. Results: Kappa was substantial or almost perfect between examiners for the dominant side, except pain referred to in the piriform muscle with 0.35 (confidence interval -95 per-mille CI: 0 - 0.92) between N1 vs. N2, 0.20 (0 - 0.66) between E1 vs. N2 and 0.27 (0 - 0.77) between E1 vs. N1 and local twitch response with 0.34 (0 - 0.70) between N1 vs. N2 for the infraspinatus muscle and 0 (0.13 - 0,80) for the upper trapezius muscle. Intraclass correlation was good or very good for all explored muscles, except for the levator scapula muscle between E1 vs. N1 with 0.68 (0.44 to 0.83) and between E1 vs. N2 with 0.69 (0.45 to 0.84). Conclusions: A substantial and/or almost perfect agreement (Kappa value) was obtained between examiners, except in the referred pain and local twitch response in some muscles. On the other hand, intraclass correlation for algometry values showed a good or very good correlation for all muscles except the levator scapula

Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged "super-thin flaps": A retrospective analysis of 82 cases in Vietnam.

BACKGROUND: The concept of the "super-thin flap" (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture. MATERIALS AND METHODS: This case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006-2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap. RESULTS: Of the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n=3) and interruption of the sutures due to infection; these required resuturing (n=2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results. CONCLUSIONS: The OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures.

Técnica de thrust para disfunción unilateral anterior del cóndilo occipital / No disponible

La disfunción anterior unilateral de occipucio es una de las lesiones más frecuentes de la articulación atlantooccipital. Dicha alteración provoca limitación de la movilidad craneo-cervical, además de otros síntomas como cefaleas y vértigos. El objetivo de la técnica de thrust para occipucio anterior unilateral es liberar la articulación fijada por el espasmo de los músculos suboccipitales posteriores, y restaurar el juego articular normal en el cóndilo lesionado, influyendo así sobre la sintomatología asociada. Una adecuada valoración diagnóstica, así como el conocimiento de las indicaciones y contraindicaciones de la técnica, son imprescindibles para la elección de la maniobra. Para su correcta ejecución es necesario conocer el posicionamiento de paciente y terapeuta, y dominar los contactos, parámetros, ajuste de tensiones y características del impulso

No disponible

Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury.

OBJECTIVE: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. DESIGN: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. RESULTS: After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14[0.04]-0.21[0.07] items/sec, P = 0.04), Action Research Arm Test (30.7[3.8]-34.3[4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5[2.3]-34[2.3], P = 0.04) grip (9.7[3.8]-12[4.3] lb, P = 0.02), and pinch strength (4.5[1.1]-5.7[1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. CONCLUSIONS: Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions.

Catastrophic cervical spinal injury in an amateur college wrestler.

A young amateur wrestler presented with a burst fracture of the seventh cervical vertebra with complete paraplegia. He was treated with surgery for spine stabilisation and was actively rehabilitated. Adolescents and teenagers are indulging in high-contact sports like wrestling, without proper training and technical know-how, which can lead to severe injuries and possibly, permanent handicap or death. Trainers, assistants and institutions should be well equipped to diagnose and provide initial care of people with a spinal injury to prevent a partial injury from progressing to complete injury. Athletes, coaches and the public should be aware of methods of first aid and how to transport a patient with a cervical spine injury. Authorities should take steps to improve infrastructures in training institutions and ambulance services. Specialised spinal centres should be established throughout the country for management and rehabilitation of patients with paraplegia.

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

BACKGROUND: It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE: The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS: Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS: Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION: The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

A case report of an adolescent with cluster headaches following neck trauma: Coincidence or trigger?

Posttraumatic headaches usually have tension-type or migraine-like characteristics. A correlation between head trauma and cluster headaches (CH) has been previously reported. CH in children are rare and require thorough differential diagnosis. We present an original case of a 15-year-old boy with cluster headaches associated with allodynia probably evoked by a neck trauma. Severe headache attacks started one month after neck trauma. At the beginning clinical presentation of our patient's headaches was very misleading. Headaches were bilateral and associated with infection. Initial diagnosis of sinusitis was made. During further observation headaches have become unilateral with typical for CH associated symptoms and additionally with allodynia. Other causes of secondary CH like cervicogenic headaches, brain tumor and vascular malformation have been excluded. The boy has undergone prophylactic treatment based on flunarizine and gabapentin with good result. Possible pathogenesis of our patient's headaches has been proposed and diagnostic traps discussed.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

BACKGROUND: Cervicogenic dizziness is a disabling condition commonly associated with cervical dysfunction. Although the growing interest with the importance of normal sagittal configuration of cervical spine, the missing component in the management of cervicogenic dizziness might be altered structural alignment of the cervical spinal region itself. AIM: To investigate the immediate and long-term effects of a 1-year multimodal program, with the addition of cervical lordosis restoration and anterior head translation (AHT) correction, on the severity of dizziness, disability, cervicocephalic kinesthetic sensibility, and cervical pain in patients with cervicogenic dizziness. DESIGN: A randomized controlled study with a 1 year and 10 weeks' follow-up. SETTING: University research laboratory. POPULATION: Seventy-two patients (25 female) between 40 and 55 years with cervicogenic dizziness, a definite hypolordotic cervical spine and AHT posture were randomly assigned to the control or an experimental group. METHODS: Both groups received the multimodal program; additionally, the experimental group received the Denneroll™ cervical traction. Outcome measures included AHT distance, cervical lordosis, dizziness handicap inventory (DHI), severity of dizziness, dizziness frequency, head repositioning accuracy (HRA) and cervical pain. Measures were assessed at three time intervals: baseline, 10 weeks, and follow-up at 1 year and 10 weeks. RESULTS: Significant group × time effects at both the 10 week post treatment and the 1-year follow-up were identified favoring the experimental group for measures of cervical lordosis (P<0.0005) and anterior head translation (P<0.0005). At 10 weeks, the between group analysis showed equal improvements in dizziness outcome measures, pain intensity, and HRA; DHI scale (P=0.5), severity of dizziness (P=0.2), dizziness frequency (P=0.09), HRA (P=0.1) and neck pain (P=0.3). At 1-year follow-up, the between-group analysis identified statistically significant differences for all of the measured variables including anterior head translation (2.4 cm [-2.3;-1.8], P<0.0005), cervical lordosis (-14.4° [-11.6;-8.3], P<0.0005), dizziness handicap inventory (29.9 [-34.4;-29.9], P<0.0005), severity of dizziness (5.4 [-5.9;-4.9], P<0.0005), dizziness frequency (2.6 [-3.1;-2.5], P<0.0005), HRA for right rotation (2.8 [-3.9;-3.3], P<0.005), HRA for left rotation (3.1 [-3.5;-3.4, P<0.0005], neck pain (4.97 [-5.3;-4.3], P<0.0005); indicating greater improvements in the experimental group. CONCLUSIONS: The addition of Denneroll™ cervical extension traction to a multimodal program positively affected pain, cervicocephalic kinesthetic sensibility, dizziness management outcomes at long-term follow-up. CLINICAL REHABILITATION IMPACT: Appropriate physical therapy rehabilitation for cervicogenic dizziness should include structural rehabilitation of the cervical spine (lordosis and head posture correction), as it might to lead greater and longer lasting improved function.

Intensive swallowing and orofacial contracture rehabilitation after severe burn: A pilot study and literature review.

BACKGROUND: Dysphagia following severe burns can be significant and protracted, yet there is little evidence describing the rehabilitation principles, process or outcomes. PURPOSE: Outline current evidence and detail the clinical outcomes of two cases who underwent a multifaceted intensive treatment programme aimed at rehabilitating dysphagia by strengthening swallow function and minimising orofacial contractures after severe head and neck burns. METHODS: Two men (54 and 18 years) with full-thickness head and neck burns and inhalation injury underwent intensive orofacial scar management and dysphagia rehabilitation. Therapy was prescribed, consisting of scar stretching, splinting and pharyngeal swallow tasks. Horizontal and vertical range of movement (HROM; VROM), physiological swallow features, functional swallowing outcomes and related distress, were collected at baseline and routinely until dysphagia resolution and scar stabilisation. RESULTS: At presentation, both cases demonstrated severely reduced HROM and VROM, profound dysphagia and moderate dysphagia related distress. Therapy adherence was high. Resolution of dysphagia to full oral diet, nil physiological swallowing impairment, and nil dysphagia related distress was achieved by 222 and 77 days post injury respectively. VROM and HROM achieved normal range by 237 and 204 days. CONCLUSION: Active rehabilitation achieved full functional outcomes for swallowing and orofacial range of movement. A protracted duration of therapy can be anticipated in this complex population.

Tradução, adaptação e validação para o português brasileiro do Data Set do trato urinário inferior para pessoas com lesão medular / Translation, adaptation and validation for Brazilian Portuguese of the Data Set lower urinary tract for people with spinal cord injury

A lesão medular (LM) é um evento catastrófico e incapacitante com importante impacto físico e psicológico, influenciando significativamente a qualidade e expectativa de vida das pessoas acometidas. Nos últimos anos, com o crescimento progressivo da violência urbana e da sobrevida das pessoas, houve um aumento importante dos casos de LM, com aproximadamente 2,5 milhões de pessoas afetadas no mundo, sendo 130.000 casos novos ao ano. As complicações decorrentes da LM são diversas, dentre elas, as disfunções do trato urinário merecem destaque, por serem responsáveis pela maior parte das morbidades e por cerca de 10% a 15% de mortalidade dessa população. No Brasil, não há instrumento específico para coleta de dados amplos para LM, como propõem os Data Sets da Spinal Cord Injury Association (ISCoS). Assim, considerando o desafio da reabilitação vesical enfrentado por esta população , o presente estudo objetivou realizar o processo de tradução, adaptação e validação do Data Set do trato urinário inferior. Tratou-se de estudo quantitativo, metodológico, de delineamento transversal, dividido nas fases de tradução, realizado segundo as recomendações da ISCoS, e teste de confiabilidade inter e intraexaminadores, testado a partir do índice AC1 proposto por Gwet e o índice Kappa, contando com uma amostra de 50 participantes. Como resultado da fase de tradução, das nove questões que compunham o instrumento, apenas quatro termos apresentaram divergências e tiveram que ser revistos; e destes, um necessitou do acionamento do comitê da ISCoS. O perfil geral dos participantes foi composto de homens , com idade média de 39 anos, com LM de etiologia traumática e tempo de lesão inferior a dois anos. A confiabilidade interexaminadores mostrou-se adequada com valores acima de 0,5 em 100% das questões testadas com índice AC1 de Gwet; para o Kappa, o índice permaneceu acima de 0,5 em 70,5% das questões e foi observado que o índice AC1 de Gwet se mostrou superior ao Kappa em relação à prevalência de respostas com alta concordância. A avaliação da confiabilidade intraexaminador mostrou que o índice AC1 de Gwet, em oito das 17 questões avaliadas, ficou abaixo de 0,5. Já o índice Kappa ficou abaixo de 0,5 em cinco das 17 questões. Isso foi atribuído às temáticas das questões que tratavam dos temas de incontinência urinária e uso de dispositivos para incontinência e ao fato de os participantes estarem inseridos em programas de reabilitação, o que ocasionou mudanças no trato urinário durante o intervalo entre entrevistas, que foi de aproximadamente duas semanas. Foi observado ainda um alto índice de participantes que realizavam o cateterismo urinário (70%) e com uso de dispositivos para incontinência urinária (64%), assim é preciso avançar em estudos para o tratamento das disfunções que promovam também a continência urinária. Este estudo realizou a tradução e a validação para o português brasileiro do Data Set do trato urinário inferior segundo as recomendações da ISCoS, corroboradas pela literatura científica, gerando um instrumento confiável de coleta de dados clínicos sobre o trato urinário inferior para ser utilizado no Brasil, contribuindo para a reabilitação das pessoas com LM

Spinal cord injury (SCI) is a catastrophic and disabling event with an important physical and psychological event, significantly influencing the quality and life expectancy of the person involved. In recent years, due to the progressive growth of urban violence and the survival of the people, there was a significant increase in cases of SCI, with approximately 2.5 million people affected worldwide, with 130,000 new cases a year. Complications arising from the SCI are numerous, and among them, the dysfunctions related to the urinary tract deserve prominence, since they are responsible for the majority of the morbidity and 10% to 15% of the mortality in this population. In Brazil, there is no specific instrument for the collection of comprehensive data for spinal cord injury, as it is the proposal presented by the Data Sets of the Spinal Cord Injury Association (ISCoS). Thus, taking into account the challenge of rehabilitation of the bladder faced by people with SCI, this study was aimed at carrying out the process of translation, adaptation and validation of the Data Set of the lower urinary tract. It was a methodological, quantitative study of transversal design, divided into phases of translation, carried out according to the recommendations of the ISCoS, and inter and intra examiners reliability test, tested from the AC1 index proposed by Gwet and the Kappa index, with a sample of 50 participants. As a result of the stage of translation, from the nine themes that make up the instrument, only four terms presented differences; and of these, only one needed actions of the Committee of ISCoS. The profile of the participants was of men, with average age of 39, with SCI of traumatic etiology and time of injury inferior to two years. Inter examiners reliability was adequate with values greater than 0.5 in 100% of the questions proven with AC1 Gwet index; for the Kappa, the index remained higher than 0.5 in 70.5% of the questions and it was observed that Gwet index AC1 was shown to be superior to the Kappa in relation to the prevalence of answers with high concordance. The evaluation of reliability Intra examiner showed that the AC1 index of Gwet, in eight of the 17 questions evaluated stayed below 0.5. The Kappa index stayed below 0.5 in five of the 17 questions. This was attributed to questions dealing with incontinence and use of devices for incontinence and also to the fact that the participants were still inserted in rehabilitation programs, which caused changes in the urinary tract during the interval between interviews, which was of approximately two weeks. A high rate of participants was observed performing urinary catheterization (70%) and use of devices for incontinence (64%), thus it is necessary to advance in the studies for the treatment of disorders which also promote continence. The present study performed the translation and validation to Brazilian Portuguese of the Data Set of the lower urinary tract according to the recommendations of the ISCoS, supported by the scientific literature, creating a reliable instrument for the collection of clinical data on the lower urinary tract to be used in Brazil, contributing to the rehabilitation of people with spinal cord injuries

Tratamiento multidisciplinar del traumatismo cervical con fractura de apófisis odontoides en militar, a propósito de un caso / Multidisciplinary treatment for cervical trauma with odontoid apophysis fracture in military member, a case report

La fractura de apófisis odontoides de la segunda vértebra cervical representa entre el 10 y el 15% de todas las fracturas cervicales. En el medio militar, esta lesión puede ser originada por la práctica de deportes, actividades de especial riesgo como el paracaidismo y armas de fuego o artefacto explosivo. Un diagnóstico precoz y un adecuado tratamiento multidisciplinar pueden colaborar para el correcto manejo integral de una baja. Se ha realizado una revisión de la literatura en la base de datos del PUBMED, utilizado la palabra clave «fractura odontoides», «sedación», «Halo-Jacket»

Odontoid fracture of the second cervical vertebra represents between 10 and 15% of all cervical fractures. In a military environment, this injury may be caused by the practice of sports, special risk such as skydiving and firearms or explosive device. Early diagnosis and appropriate multidisciplinary treatment can work for the proper management of a casualty. A literature review has been carried out in PUBMED database, using the keywords «fractura odontoides», «sedación», «Halo-Jacket»

[The relationship between scapular dyskinesia, pain, range of motion, and flexibility in patients with neck and shoulder problems]. / Boyun ve omuz agrili olgularda skapular diskinezi, agri, eklem hareket açikligi ve esneklik arasindaki iliski.

OBJECTIVES: To investigate the relationship between scapular dyskinesia, pain, and flexibility in patients with neck, shoulder, or both injuries. METHODS: A total of 160 patients who came to Baskent University Hospital, Department of Physical Medicine and Rehabilitation with pathology and pain in the neck and shoulder regions were included to our study. Patients were divided into three groups; Neck group, shoulder group and neck+shoulder group. Visual Analog Scale (VAS) for pain intensity, goniometer for range of motion, and tape measurement for evaluation of flexibility was used. Lateral Scapular Slide Test (LSST) and Scapular Retraction Test (SRT) vs Skapular Assisstance Test (SAT) were used for evaluation of scapular dyskinesia. RESULTS: SRT (r=0.617, p=0.000) and SAT (r=0.565, p=0.000) positivity was found to be correlated with dominant and non-dominant sides in patients with neck pathology. Pain at night and during rest were found to correlate with pain during activity in patients with neck+shoulder pathology (r=0.572, p=0.002). No significant correlation was found between pain intensity and scapular dyskinesia in all groups. LSST values were found under 1.5 cm and therefore, scapular mobilization was considered as normal (LSST1=0.76±0.74; LSST2=0.68±0.81; LSST3=0.75±0.75). CONCLUSION: In addition to joint limitations and flexibility, scapular dyskinesia should also be evaluated in order to solve problems related to pain in patients with neck, shoulder and neck+shoulder pathology. In future studies, the classification of groups according to pathology may help to understand the impact of scapular dyskinesia on the pathology of shoulder and neck pain.

Thyroid storm following suicide attempt by hanging.

Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with ß-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.

Effects of cervical spine manual therapy on range of motion, head repositioning, and balance in participants with cervicogenic dizziness: a randomized controlled trial.

OBJECTIVE: To evaluate and compare the effects of 2 manual therapy interventions on cervical spine range of motion (ROM), head repositioning accuracy, and balance in patients with chronic cervicogenic dizziness. DESIGN: Randomized controlled trial with 12-week follow-up using blinded outcome assessment. SETTING: University School of Health Sciences. PARTICIPANTS: Participants (N=86; mean age ± SD, 62.0 ± 12.7 y; 50% women) with chronic cervicogenic dizziness. INTERVENTIONS: Participants were randomly assigned to 1 of 3 groups: sustained natural apophyseal glides (SNAGs) with self-SNAG exercises, passive joint mobilization (PJM) with ROM exercises, or a placebo. Participants each received 2 to 6 treatments over 6 weeks. MAIN OUTCOME MEASURES: Cervical ROM, head repositioning accuracy, and balance. RESULTS: SNAG therapy resulted in improved (P ≤.05) cervical spine ROM in all 6 physiological cervical spine movement directions immediately posttreatment and at 12 weeks. Treatment with PJM resulted in improvement in 1 of the 6 cervical movement directions posttreatment and 1 movement direction at 12 weeks. There was a greater improvement (P<.01) after SNAGs than PJM in extension (mean difference, -7.5°; 95% confidence interval [CI], -13° to -2.0°) and right rotation (mean difference, -6.8°; 95% CI, -11.5° to -2.1°) posttreatment. Manual therapy had no effect on balance or head repositioning accuracy. CONCLUSIONS: SNAG treatment improved cervical ROM, and the effects were maintained for 12 weeks after treatment. PJM had very limited impact on cervical ROM. There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness.

Effects of cervical orthoses on neck biomechanical responses during transitioning from supine to upright.

BACKGROUND: Our objectives were to use a hybrid cadaveric/surrogate model to evaluate the effects of the cervicothoracic orthosis and collar on head and neck biomechanical responses during transitioning from supine to upright. METHODS: The model consisted of an adult-male surrogate dummy with its artificial neck replaced by a human neck specimen (n=10). The model was transitioned from supine to upright using a rotation apparatus. A high-speed digital camera tracked motions of the head, vertebrae, cervicothoracic orthosis, pelvis, and rotation apparatus. Head load cell data were used to compute occipital condyle loads. Average peak spinal loads and motions were statistically compared (P<0.05) among experimental conditions (cervicothoracic orthosis: anterior strut locked and unlocked; collar; and unrestricted). FINDINGS: Loads at the occipital condyles consisted of anterior shear, compression, and extension moment. The most rigid device tested, cervicothoracic orthosis with anterior strut locked, significantly reduced axial compression neck force and increased anterior shear neck force and provided the greatest immobilization by significantly reducing spinal rotations as compared to other experimental conditions. Similar neck biomechanical responses were observed between the cervicothoracic orthosis, anterior strut unlocked, and collar. INTERPRETATION: The simple maneuver of supine-to-upright transitioning, commonly performed clinically, produced complex neck loads and motions including head protrusion which caused cervical spine snaking. Neck motions consisted of extension at the upper cervical spine and flexion at the subaxial cervical spinal levels. Of the devices tested, the cervicothoracic orthosis, with anterior strut locked, provided the greatest cervical spine immobilization thereby reducing the risk of potential secondary neck injuries.

Development of a cumulative psychosocial factor index for problematic recovery following work-related musculoskeletal injuries.

BACKGROUND: Psychosocial variables such as fear of movement, depression, and pain catastrophizing have been shown to be important prognostic factors for a wide range of pain-related outcomes. The potential for a cumulative relationship between different elevated psychosocial factors and problematic recovery following physical therapy has not been fully explored. OBJECTIVE: The purpose of this study was to determine whether the level of risk for problematic recovery following work-related injuries is associated with the number of elevated psychosocial factors. DESIGN: This was a prospective cohort study. METHODS: Two hundred two individuals with subacute, work-related musculoskeletal injuries completed a 7-week physical therapy intervention and participated in testing at treatment onset and 1 year later. An index of psychosocial risk was created from measures of fear of movement, depression, and pain catastrophizing. This index was used to predict the likelihood of experiencing problematic recovery in reference to pain intensity and return-to-work status at the 1-year follow-up. RESULTS: Logistic regression analysis revealed that the number of prognostic factors was a significant predictor of persistent pain and work disability at the 1-year follow-up. Chi-square analysis revealed that the risk for problematic recovery increased for patients with elevated levels on at least 1 psychosocial factor and was highest when patients had elevated scores on all 3 psychosocial factors. LIMITATIONS: The physical therapy interventions used in this study were not standardized. This study did not include a specific measure for physical function. CONCLUSIONS: The number of elevated psychosocial factors present in the subacute phase of recovery has a cumulative effect on the level of risk for problematic recovery 1 year later. This research suggests that a cumulative prognostic factor index could be used in clinical settings to improve prognostic accuracy and to facilitate clinical decision making.